Barriers and Facilitators to HIV Pre-Exposure Prophylaxis Uptake among Men Who Have Sex with Men Who Use Stimulants: A Qualitative Study

The HIV epidemic disproportionately impacts men who have sex with men (MSM), particularly those who use stimulants. We explored barriers and facilitators to pre-exposure prophylaxis (PrEP) uptake among this population. From June 2018 through February 2019, we conducted semi-structured interviews in Providence, Rhode Island, and New Haven, Connecticut, with 21 MSM who reported recent (past six months) stimulant use. We identified individual, interpersonal, and structural barriers to PrEP, including: 1) high awareness but mixed knowledge of PrEP, resulting in concerns about side effects and drug interactions; 2) interest that was partly determined by substance use and perceived HIV risk; 3) fragmented and constrained social networks not conducive to disseminating PrEP information; and 4) PrEP access, such as insurance coverage and cost. Our findings suggest potential approaches to increase PrEP uptake in this group, including promotion through mainstream and social media, clarifying misinformation, and facilitating increased access through structural interventions.